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The aim of this study was to compute the average kinship coefficient of cancer cases in an extreme isolate (Lastovo Island, Croatia) and to compare it to the corresponding value for the island’s unaffected population. Kinship estimates were obtained by Wright’s path method (ϕ) based on pedigree reconstruction and Lasker’s coefficient of relationship by isonymy (Ri) based on surname distribution. A total of 76 cancer cases were recorded on the island between 1971 and 1995. The unaffected control population of 1144 persons was obtained from the population census in 1971. The data on five ancestral generations were collected from parish registries preserved in the local church, and included 5484 persons born on the island between 1750 and 1970. Both Wright’s path method and Lasker’s isonymy method indicated significantly greater kinship of female cancer cases than of the unaffected population. Cancer cases with increased values of Ri among them and Ri among their ancestors included cancers of the ovary, colon, brain, breast, and prostate and leukemias. This study confirms the role of heredity and common ancestry in the development of cancer, providing a rough insight into their relative importance for specific cancer sites.